Restorative Stomatology

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During a treatment of dental caries and its consequences we should consider whether we treat a temporary or permanent tooth and what stage of development the tooth and its root are at. A degree of a root’s resorption should be evaluated on X-ray images of temporary teeth. Principles of a cavity preparation are the same for children’s temporary and permanent teeth as for adults, except the temporary frontal teeth. The same filling materials are used, just Evicrol should not be used for temporary teeth and permanent teeth with an incomplete root development. Resorbing filling materials should only be used for filling of root canals of temporary teeth. In case of permanent teeth with complete development, methods of treatment and materials for root canals filling are the same as those for adults. Endodontic treatment of teeth with incomplete development is very difficult. If a root is very short, one should not hesitate to perform an extraction, even at frontal region. In case of partial pulp inflammation, a vital pulpotomy of a crown pulp is performed. A typical method of children’s stomatology is apification that has been used successfully for the following diagnoses: pulp necrosis, gangrene, and acute periodontitis. The method decreased to a minimum the need for surgico-conservative therapy of teeth with incomplete development (so called filling under visual control). The apification method is based on high biological activity of the tissue at an open root apex (mesenchymal papilla). Teeth with the above described diagnoses are filled repeatedly with Calxyd. The root’s closure should occur at 6 to 24 months, although the root may remain shorter. Indeed, it may reach its normal length (so called apigenesis).

Prevention of dental caries.

Dental caries prevention may be either local or systemic.

Systemic prevention may be applied during the period of teeth development only. It consists in sufficient supply of proteins, minerals and vitamins, especially A and D; fat and polysaccharides must not be absent either. An enamel’s resistance against decay is significantly influenced by fluorine. For this reason, fluoridation of a drinking water at an optimal dose of 1 mg of a fluorine compound per 1 liter of water is used. Fluorine becomes introduced into hydroxyapatite crystalline structure thus forming hydroxyfluoroapatite that is more resistant to acids. Fluorine also replaces CO₃ ions, binds to the organic matrix of enamel and influences to a certain extent positively formation of the teeth occlusal planes. Fluorine contained in saliva suppresses metabolism of microorganisms that contribute to formation of dental decay. It also influences tonus of capillaries thus improving the gingiva’s blood supply. Fluorine’s anti-carious properties may only be active when it is supplied to an organism for at least 300 days a year. At places where a drinking water fluoridation does not take place, fluoride tablets are administered to children. High doses of fluorine impair building of an enamel, however. Some brands of mineral water used for dilution of milk baby formulas contain high concentration of fluorine and are not suitable for babies (e.g. Mattoniho kyselka, Praga). On the other hand, “Ida” brand mineral water is suitable, it contains 0.29 mg F per 1 liter.

Local prophylaxis is applied to erupted teeth. It consists in increasing the enamel’s resistance and limiting activity of harmful substances. Enamel’s resistance is increased upon fluorine treatment of teeth surfaces. Fluorine ions penetrate 100 - 200 µm in depth, their bond is not stable, however, and fluorine supply has to be repeated. Aqueous solutions of sodium fluoride or fluorine aliphatic monoamines (Elmex) in forms of varnishes or gels are mostly used. Some brands of toothpaste contain fluorine as well. It is possible to decrease an action of harmful substances on an enamel by proper diet composition that excludes cariogenous foods, such as saccharose. Our daily diet should be complemented by solid foods with self-cleaning properties (apples, raw vegetables, hard cheese, dark bread). Proper dental hygiene plays an important role in fighting caries. Effective teeth brushing removes dental plaques and reduces number of microbes in oral cavity. Proper oral care has to start at early child’s age by learning the right brushing technique, selection of a good toothbrush and toothpaste. Toothpastes that contain fluorine and have pleasant tastes are recommended (Fluorka, Tuti Fruti, Gabi, Perlička).